Background: Since the first report in 1980, organ-function-preserving pancreatectomy has been increasingly performed in patients with benign or low-grade malignant lesions, in order to decrease the loss of normal pancreatic tissue. The aim of this study was to evaluate our experience with limited pancreatic resections with attention to perioperative and long-term outcome.
Methods: From November 1985 to December 2005, 54 patients underwent segmental pancreatectomy: 30 patients had central pancreatectomy (CP) and 24 had duodenum-preserving pancreatic head resection (DPPHR). Ten patients who underwent CP (Sperti C et al., J Am Coll Surg 2000;190:711-718) and 13 patients who underwent DPPHR (Pedrazzoli S et al., Pancreas 2001;23:309-315) were previously reported. There were 19 males and 35 females, with mean age of 50.2 years (range 13-74 years). The pathologic diagnosis was: serous cystadenoma (13), insulinoma (9), nonfunctioning endocrine tumor (9), Intraductal Papillary Mucinous Neoplasm (7), chronic pancreatitis (7), mucinous cystadenoma (4), metastasis from renal cell carcinoma (2), papillary-cystic tumor (1), biliary cyst (1), and solitary true cyst (1).
Results: There were no operative death. Postoperative course was uneventful in 27 patients (50%). Complications occurred in 15/30 CP and 12/24 DPPHR. In particular a pancreatic fistula was diagnosed in 13/30 CP (43.3%) and in 3/24 DPPHR (12.5%), a biliary fistula in 5/24 DPPHR (20.8%) (1 reoperation), an abdominal abscess in 2/24 DPPHR (1 reoperation), a peritoneal bleeding in 1 CP and 1 DPPHR (1 reoperation), a digestive bleeding in 1/24 DPPHR and a pneumonia in 1 CP.After a median follow-up of 48 months (range 23-264) only one patient recurred after a CP for renal cancer metastases: she underwent pancreaticoduodenectomy and partial resection of the residual body-tail. Four patients developed type two diabetes [2 after CP (6.9%) and 2 after DPPHR (8.7%)]; one CP and one DPPHR patient were diabetics before surgery. Ten patients (18%) required pancreatic enzyme supplementation.
Conclusions: Segmental pancreatic resection preserves long term endocrine and exocrine function in a significant proportion of patients. While operative mortality is absent, this type of surgery is associated with a high complication rate, even in experienced hands. This is due to the presence of a normal pancreas, at high risk of pancreatic fistula, in almost all patients. The incidence of biliary fistula decreased with increasing experience. Therefore, caution is necessary when using these procedures, accurate selection of the patients being essential.